Dr. Frank Spinelli: Cruise Control

As doctors, we do our best. I counsel my patients about drugs and sexually transmitted diseases, including HIV. Although I feel confident in my abilities, I still picture my nephews’ eyes rolling into the back of their heads when I try to instill some sense of caution in my patients before a circuit event. I don’t judge, or at least that is what I tell myself. But I suppose I do. I stopped going out years ago when it became a never-ending merry-go-round of witnessing overdoses and re-treating STDs. I tell myself I’m getting older. When I was younger, I didn’t listen either, but the age of the modern-day party boy is well beyond the age when any of us should be referring to each other as “boy.” I’ve read that the average age of an Atlantis cruise ship passenger is 41.

The trouble with gay men is that, like teenagers, they fall prey to the rush of hormones that drive the reward-system network. Essentially, this is the spot in the brain that reacts to desire or a bump of crystal. The body responds to this reward-system network by releasing the neurotransmitters dopamine and norepinephrine. Cocaine raises dopamine levels 400% above normal, and methamphetamine triggers a 1,500% increase in dopamine. Although dopamine affects many parts of the brain and body, the effect is most important on two brain sites: the nucleus accumbens and the ventral tegmentum. These two brain sites are connected by a bundle of cells called the mesolimbic pathway, or the brain-reward center. This is the area of the brain that is most powerfully associated with pleasure and addiction. Stimulating this pathway makes a person want to repeat this behavior in order to feel the reward it brings. Unfortunately, that reward is never truly like the first time — no matter how much sex you have or how many bumps you take.

Of course, the obvious culprit is that we are fueled by our desires, whether these are sexual or drug-fueled escapes, especially when these desires have been liberated after years of confusion and confinement. Who wouldn’t want to go on a sex, drug, and alcohol binge while drifting through the Caribbean on a gay cruise where there are no judgmental eyes watching your every move?

On February 6 the Royal Caribbean ship Allure of the Seas set sail from Port Everglades, Fla. In what was billed as the largest gay cruise ever, Atlantis hosted more than 5,400 passengers. “Where does it go?” I asked one patient as he reviewed a list of prescriptions he would need for his upcoming trip: Cialis, Xanax, and Ambien ...

“Who cares,” he said. “I’m never getting off the boat.” Several days later the text messages started to arrive, “This trip is a disaster. Guys are overdosing left and right. The authorities boarded the ship and arrested a drug dealer. They have dogs and they’re making surprise room searches.”